As kava use becomes increasingly widespread, so has another herbal product known as kratom. Kava and kratom both have long histories going back centuries, can be consumed as teas, and are psychoactive. However, their similarities stop there. Even though kratom may be sold alongside kava, they are completely different in their histories as well as their chemical compositions and pharmacological effects—to state the somewhat obvious, they are absolutely NOT the same nor are they interchangeable. This begs the question, what exactly is kratom? And how does it differ from kava?
What is Kratom?
“Kratom” refers to a group of tree-like plants from the Mitragyna genus of the Rubiaceae family. For hundreds of years in Southeast Asia, kratom leaves have been brewed as a tea (or chewed raw) for their opioid-like pharmacological effects in order to help workers stave off fatigue. Moderate to high doses (5-15 grams) have been used for the management of pain, diarrhea, and opioid withdrawal symptoms while very high doses (over 15 grams) can be quite sedating and induce stupor. Outside of the Southeast Asia, kratom has been increasingly used for its pharmacological effects including by individuals for the self-management of opioid withdrawal and pain.
Figure 1: Map of Southeast Asia
Pharmacology of kratom
Kratom has at least 20 different active compounds most of which have major pharmacological effects that can be opioid-like and/or stimulant-like. Compounds in kratom leaves can “interact with opioid receptors in the brain, producing sedation, pleasure, and decreased pain.” Users have also reported “increased energy, sociability, and alertness instead of sedation.”
The presence of pharmacologically active compounds undoubtedly has potential toxicities and thus kratom can also reportedly cause uncomfortable and sometimes dangerous side effects depending on who is consuming it, how it is consumed, how much is consumed, and with what other substances it is consumed with.
Is kratom safe?
Kratom has recently and increasingly gained prominence outside of Southeast Asia and is readily available from Internet-based suppliers as well as “kratom bars” and, even more commonly, supposed “kava bars.”
In the U.S., the DEA classifies and regulates kratom as an “herbal product” and is not prohibited or banned. However, kratom is on the DEA’s Drugs and Chemicals of Concern watch list—it is worth highlighting and further distinguishing kava from kratom by pointing out that kava is not on this DEA list. The DEA’s official position on kratom goes on to state that “there is no legitimate medical use for kratom in the U.S.” and thus “it cannot legally be advertised as a remedy for any medical condition.” Another example of institutional resistance to kratom can be reflected in the Mayo Clinic’s official page on it which is titled, “Kratom: Unsafe and ineffective.”
A review of kratom by the Journal of the American Osteopathic Association concluded that although, “in pure herbal form, when taken at moderate doses of less than 10 to 15 g, pure leaf kratom appears to be relatively benign in the vast majority of users”, it would not be appropriate for physicians to recommend kratom for their patients without reported evidence from well-controlled clinical trials. The author did, however, point out the complex questions that arise from that knowledge gap such as “Who would fund this type of study? Given that kratom is a tree, would pharmaceutical companies support such work? Would institutional review boards be reluctant to approve trials for a schedule 1 substance?”
What does kratom mean for kava?
Kava is native to the pacific islands, non-narcotic, holds ritualistic/ceremonial importance, and is traditionally consumed as a social beverage. On the other hand, kratom is native to Southeast Asia, narcotic, and traditionally used for medicinal purposes.
There is much left to be said about kratom as well as much left uncertain. However, one thing for certain is that kratom is NOT kava and is very distinct from kava in a number of critical ways. Although this is the case, kava and kratom are often associated with each other and sold alongside each other in many supposed “kava bars.”
The relationship between kava and kratom in the market warrants consumers to be continuously informed about whatever they choose to consume. The relationship between kava and kratom in the market is also one that needs to be further understood and warrants a deeper investigation.